Preface
I grew up in an atmosphere of serious food, serious eating, and—ultimately—serious medicalconsequences. My grandmother was a professional chef and caterer on Miami Beach in the '40s and '50s and a trulygreat Jewish cook. She made delicate, fluffy matzoh balls, quenelle-like gefilte fish, and unforgettably sweet,schmaltzy chopped liver. She used three types of bones in her stocks and deglazed her pans with wine before JuliaChild ever appeared on PBS. Twenty years after her death, people still yearn for her savory stuffed breast of veal.As a baker, she was half artist, half magician. She made the moistest honey cake and the mellowest, translucentstrudel. Her teglach, rugalach, and buttery polymorphous cookies sweetened Jewish celebrations in SouthFlorida for two generations.
Unfortunately, my grandmother was also morbidlyobese and, from mid-adulthood on, she battled twolife-threatening complications of obesity: cancerand cardiovascular disease. Although she lived formany years following breast cancer surgery, theywere years of hypertension, angina, congestive heartfailure, multiple medications, side effects, anddeclining activity.
My grandmother had three food-loving sons.Two became obese adults with significant cardiovasculardisease. One of them required bypass surgery (as hasone of his obese children). The third son, my father, isan exceptional cook (and loves his own cooking!), buthe has kept himself healthy through moderation andregular exercise.
I am clearly his daughter in many ways, but innone so marked as my lifelong interest in food andhealth. Between college and medical school, I workedmy way through both volumes of Mastering the Art ofFrench Cooking. During medical school, I studied hardand ate well. Jogging kept me trim and fit.
When I married my husband (also a physician) in1984, the prevailing nutritional wisdom supported ahigh-carbohydrate, low-fat diet for weight control andcardiovascular health. We lived on pasta of every colorand shape, polenta, couscous, bulgur, tortillas, millet,barley, wheat berries, quinoa, potatoes, and rice. I mademy own bread and pizza, gnocchi and spaetzle. I boughtnonstick pots and cooked with as little fat as possible.Protein appeared only at dinner, usually in the form offish or chicken. To limit cholesterol and saturated fat,we ate no butter, eggs, or cheese and little red meat.Following my father's example, I maintained a rigorousdaily exercise program that combined running withstair climbing, stationary bicycle, and skiing and rowingequipment.
To my infinite disappointment and frustration,ten years of this disciplined lifestyle resulted in a slowand steady weight gain and a "borderline" serumcholesterol. I also developed an array of musculoskeletalaches and pains from exercise-induced overuseinjuries. When anti-inflammatory medications failedto help, I spent a small fortune on alternative therapies.I felt tired all the time and found myself going to bedearlier and earlier. My productivity diminished. At 44,I thought I was sliding into the inevitable physicaldeterioration of middle age. I was desperate and readyto try anything.
At a party, I chatted with a friend and fellowphysician who suffered from a debilitating chronic disease.When I remarked on his robust appearance, hetold me about his recent improvement on the Zonediet. In particular, he noted a dramatic increase in energyand an enhanced sense of well-being. The very nextday, I bought and read The Zone by Dr. Barry Sears. Twodays later, my husband and I began the Zone diet—thequintessential insulin-modulating regimen. Almostimmediately, I discovered some of the benefits of betterinsulin control (weight loss, increased energy, painrelief) and I wanted to enjoy them for the rest of mylife.
I could face a future without grain and potatoes,but there was one thing I could not give up: my passionateinterest in cooking and food. Instinctively, Idrew away from mathematically precise food formulasthat made me feel hemmed in and restless. Instead, Isought adventures in cooking and eating that wouldserve the goal of insulin modulation. This book presentsthe best of my three years of insulin-conscious cooking.
-Deborah Friedson Chud, M.D.
Chapter One
Cooking for Insulin Modulation and Flavor
What do The Zone,Sugar Busters!, Dr. Atkins' New Diet Revolution, Dr. Bob Arnot's Revolutionary Weight Control Program,Protein Power, and all other "modified carbohydrate" diets have in common? They share a hormonalstrategy for weight loss, blood sugar control, enhanced athletic performance, and improved cardiovascularhealth. If you eat (or try to eat) according to one of these programs, you are using food to affectyour levels of the hormone insulin. In other words, you are practicing insulin modulation. | This isnot a diet book; it is a cookbook for exuberant health. It supports insulin modulation through bold,imaginative, flavorful food.
INSULIN MODULATION
In recent years, researchon insulin activity has become vigorous and controversial.Certainly many issues and mechanisms remainunclear. However, a growing body of evidence points toinsulin as a major player in the failure of high-carbohydrate,low-fat diets to control obesity, cardiovasculardisease, and type 2 (adult-onset) diabetes in this country.My perspective on insulin derives from the scientificliterature on glycemic index and low-glycemic dietsand the popular books by Drs. Sears, Arnot, Atkins,Eades, and the Sugar Busters! team of Steward, Bethea,Andrews, and Balart.
Insulin influences appetite. When the carbohydratesyou eat enter the bloodstream in the form of glucose,blood sugar levels rise. In response, the pancreas secretesinsulin, which sends blood sugar levels down again. Thisleads to the sensation of hunger. The faster the insulinresponse, the faster you feel hungry again after meals."Carbohydrate craving" is the term some people use todescribe this kind of rapid cycling. It commonly occursafter high-carbohydrate, low-fat meals.
Insulin also influences fat metabolism. It puts thebody in the storage mode and prevents stored fat frombeing used as an energy source. No matter how muchyou exercise, you may find the fat-storing and fat-lockingactions of insulin difficult to overcome. If youhave had trouble losing fat on a high-carbohydrate,low-fat diet, it may be due to your response to somuch carbohydrate. Scientific evidence suggeststhat cardiovascular complications follow from thisas well. High insulin levels correlate with highlevels of triglycerides and low levels of HDL (goodcholesterol). This blood lipid configuration raisescardiovascular risk.
Insulin-modulating diets limit fat storage andpromote fat burning by controlling the insulin responseto food. They alter the insulin response by adjusting themacronutrient composition of meals (ratios of carbohydrateto protein to fat). They also control insulin bylimiting the intake of certain carbohydrates (sugar andgrains) and relying more on others (high-fiber fruitsand vegetables).
Insulin-modulating meals contain less carbohydrate,more protein, and more fat than high-carbohydrate,low-fat meals. You eat less carbohydrate and morefat to slow down insulin secretion and lower averageinsulin levels. You eat more protein to enhance secretionof glucagon, a hormone whose actions oppose those ofinsulin. (Glucagon helps release stored fat for energy use.)These changes promote weight loss and fat loss bydecreasing fat storage, increasing fat burning, and delayingthe onset of hunger after meals.
Insulin-modulating diets emphasize certain typesof carbohydrates. Some carbohydrates convert to glucoseand enter the bloodstream more slowly than others.These carbohydrates produce a slower insulin response,less rapid cycling, and less subsequent carbohydratecraving. They minimize fat storage and maximize fatburning by lowering and stabilizing average insulinlevels. They are known as "low-glycemic carbohydrates."Examples include fructose, grapefruit, cherries, lentils,and most high-fiber vegetables.
Insulin-modulating diets tend to be low-glycemicdiets. The "glycemic index" of a fooddescribes its rate of conversion to glucose and releaseinto the bloodstream relative to other foods. Foodsthat convert and release quickly (for example, Frenchbread) are fast insulin stimulators with a highglycemic index. Foods that convert and release slowly(for example, cherries) are slow insulin stimulatorswith a low glycemic index.
My approach to insulin control has two components.I improve the glycemic profile of meals by creatingcarbohydrate recipes that do not send blood sugarskyrocketing. Then I slow down insulin response evenfurther by balancing those carbohydrates with proteinand fat. The proportions of macronutrients in any mealcan reflect any diet orientation, and this involvespersonal choice. You can follow a specific regimenstrictly or loosely, or you might develop a whollypersonal strategy (such as "more protein, less pasta").
The popular insulin-modulating diets differ substantiallyin the macronutrient ratios they recommend. Dr.Arnot's diet appears at the higher-carbohydrate, lower-protein,lower-fat end of the spectrum with 55 to 65percent carbohydrate, 20 to 25 percent protein, and 15 to20 percent fat. The Zone diet occupies the middle groundwith a 40/30/30 allocation of calories from carbohydrates,protein, and fat. The Atkins, Protein Power, andSugar Busters! programs are lower-carbohydrate, higher-protein,higher-fat diets. The path to the "right" balanceinvolves a combination of faith and experimentation.If you have gained weight or failed to lose weight on ahigh-carbohydrate, low-fat regimen, insulin controlmight work dramatically for you.
Regardless of specific diet philosophy, insulin-consciousmeal planning employs protein and fat tocounter the hormonal effects of carbohydrates in everymeal and snack. To help you with this, I have dividedrecipes into two major chapters: Protein Dishes andCarbohydrate Dishes, instead of the traditional categoriesof appetizers, main dishes, and side dishes. The specialchapter entitled Condiments and Flavor Enhancerscontains recipes for an array of low-glycemic carbohydratesthat make food more delicious without causinginsulin spikes.
Where's the fat? Even the leanest protein sourcescontain intrinsic fat. In addition, almost every recipecontains a small quantity of added fat—usually in theform of olive oil or nut butter. These ingredients consistprimarily of monounsaturated fats, which have cardiovascularbenefits and, in the quantities used here, do notaffect insulin. My personal assessment of good culinaryresults (great flavor), rather than mathematics,determined the amount of fat used in each dish.
My cooking style evolved along parallel insulin-controllingand gourmet-satisfying tracks. You can cookhealthfully from the recipes in this book, but—again—itis not a diet book, and I do not prescribe a specificprogram. The recipes help control insulin levels byemploying those carbohydrates that convert to glucosemore slowly than others. Meal planning then requires apersonal decision about macronutrient ratios. If youneed help tailoring a diet to your individual needs, youmay need to consult a nutritionist or a diet book.
Moroccan Chicken Thighs
4 SERVINGS
This fragrant chicken stew, loosely adapted fromSheryl Julian and Julie Riven of the Boston Globe, illustrates one of the many uses of roasted eggplant. Sincethe eggplant simmers in the sauce for 10 minutes, roast it until it is tender but not soft, or it will disintegrateduring the final cooking. I generally leave the skin on, but you can peel it if you wish before cutting it into cubes.If you do not have roasted eggplant, zucchini cut into 1-inch chunks will cook in the allotted time. The stew isexcellent (perhaps even better) reheated the next day.
NUTRITIONAL ANALYSIS PER SERVING:
388 CALORIES, 34 G PROTEIN, 23 G CARBOHYDRATE, 17 G FAT (4 G SATURATED), 99 MG CHOLESTEROL, 558 MG SODIUM, 7 G FIBER
8 bone-in chicken thighs, skin and visible fat removed
Salt and freshly ground black pepper
1 tablespoon extra virgin olive oil
1 cup chopped onion
1 tablespoon minced fresh ginger
1 tablespoon minced garlic
2 cinnamon sticks
1 teaspoon ground cumin
1 cup diced canned tomatoes, drained
1½ cups chicken broth
1 cup cooked and drained chickpeas
3 cups cubed Roasted Eggplant (1-inch cubes) (page 30)
2 tablespoons minced flat-leaf parsley
1. Season the chicken generouslywith salt and pepper. Heat the oil ina large nonstick skillet or Dutchoven over medium-high heat. Addthe chicken and brown well on bothsides; then remove from the skillet.
2. Reduce the heat to medium.Add the onion and sauté, stirring,until soft, about 3 minutes. Add theginger, garlic, cinnamon sticks, andcumin. Cook, stirring, for 1 minute.Add the tomatoes, broth, and saltand pepper to taste. Return thechicken with any accumulatedjuices to the pan. Baste with thesauce. Cover and simmer for 15minutes. Add the chickpeas androasted eggplant and simmerfor 10 minutes.
3. Adjust the seasoning and removethe cinnamon sticks. Garnish withthe parsley. Serve immediately.
Zone yield per recipe: 16 proteinblocks, 7 carbohydrate blocks
Spiced Turkey Kebabs
4 SERVINGS
During the summer, my local market offers "Londonbroil-style" turkey—half a skinless boneless breast in the form of a thick steak. I cube it, marinate it overnightin Indian spices, and grill it the next day. The meat can be skewered with or without the usual shish kebabcompanions (peppers, onions, cherry tomatoes). If, however, you seek adventure, try combining this recipe withBroiled Fruit Skewers (page 205). Many fruits respond well to broiling and substitute brilliantly for high-glycemicchutneys. | The recipe provides plenty of extra spice mixture to use with chicken, duck, lamb, and pork. Store theexcess in an airtight container in a cool, dark place and use it as needed. It should keep for up to 6 months.
NUTRITIONAL ANALYSIS PER SERVING:
178 CALORIES, 26 G PROTEIN, 2 G CARBOHYDRATE, 7 G FAT (2 G SATURATED), 58 MG CHOLESTEROL, 297 MG SODIUM, 0 G FIBER
Spice Mix
1 tablespoon ground cumin
1 tablespoon ground coriander
1 tablespoon turmeric
½ to 1 teaspoon cayenne pepper
1 tablespoon salt
1 teaspoon freshly ground black pepper
1 tablespoon peanut or canola oil
1 tablespoon minced garlic
1 tablespoon minced fresh ginger
2 tablespoons minced onion
1 1/3 pounds boneless skinless turkey breast, cut in l ½-inch chunks
1. To make the spice mix, combinethe cumin, coriander, turmeric,cayenne, salt, and pepper in a smallnonstick skillet over medium heat.Cook, stirring, for 2 to 3 minutesuntil fragrant. Remove from theheat and set aside to cool. Measureout 2 teaspoons (or more to taste)into a medium-sized bowl. Reservethe extra for another use.
2. Add the oil, garlic, ginger, andonion to the spice mix. Whisk toblend. Add the turkey chunks andtoss well to coat. (The turkey canbe set aside in the refrigerator forup to 24 hours at this point.)
3. Preheat the broiler or preparea hot fire in the grill. Thread theturkey chunks loosely on skewers.Broil or grill 4 inches from theheat for about 4 minutes. Turn,broil, or grill for approximately4 minutes longer, or until theturkey is cooked through butnot dry. Serve immediately.
Zone yield per recipe: 16 proteinblocks, 1 carbohydrate block
Hot Stir-Fried Green Beans
4 SERVINGS
Because of their year-round availability andrapid cooking, I find green beans almost indispensable. I always keep plain boiled ones on hand to throw intosalads and eat with dips. However, when life permits, I treat them more respectfully, as in the Chinese preparationbelow. If you happen to have cooked green beans in your refrigerator, take the following short-cut: Heat the oil,make the sauce, and add the beans at the end just to heat them through.
NUTRITIONAL ANALYSIS PER SERVING:
98 CALORIES, 3 G PROTEIN, 14 G CARBOHYDRATE, 4 G FAT (1 G SATURATED), 0 MG CHOLESTEROL, 560 MG SODIUM, 4 G FIBER
Sauce
1 tablespoon bean sauce
1 tablespoon Shaoxing rice wine
1 tablespoon soy sauce
1 teaspoon fructose
1/3 cup chicken broth
1 tablespoon peanut or canola oil
4 cups trimmed green beans
1 tablespoon minced garlic
1 tablespoon minced fresh ginger
2 tablespoons minced scallions (white parts only)
½ teaspoon hot red pepper flakes
1. To make the sauce, combinethe bean sauce, rice wine, soy sauce,fructose, and Chicken broth in asmall bowl or measuring cup andwhisk to dissolve the fructose.Set aside.
2. Heat the oil in a nonstick wokor large skillet over medium-highheat. Add the beans and stir-fry for3 minutes. Add the garlic, ginger,scallions, and pepper flakes andstir-fry for another minute. Add thesauce mixture and stir-fry for 1 to2 minutes. Serve immediately.
Zone yield per recipe: Less thanone protein block, 4 carbohydrateblocks
Broiled Fruit Skewers
4 SERVINGS
Availability, cost, and protein companion determine mychoice of fruits for this recipe. I use apples and pears in winter; peaches, plums, and nectarines in summer; andfresh pineapple whenever it's cheap. If you wish to brush the fruits with a little oil, I suggest peanut or macadamianut, but they cook perfectly well without it. Broiling them au naturel allows you to save your fat coupons forthe rest of your meal. Double skewer the fruit for easy turning. | Served warm or at room temperature, these fruitscomplement grilled or roasted meats, especially turkey, pork, duck, and lamb. They particularly enhance proteindishes with Indian flavors by serving as low-glycemic chutney surrogates. They are lovely additions to composedsalads and even work as dessert. Leftovers are delicious cold or reheated in the microwave. If you like, garnish themwith chopped fresh basil, mint, or tarragon. (Pictured on page 111.)
NUTRITIONAL ANALYSIS PER SERVING:
43 CALORIES, 0 G PROTEIN, 11 G CARBOHYDRATE, 0 G FAT (0 G SATURATED), 0 MG CHOLESTEROL, 0 MG SODIUM, 2 G FIBER
1 firm apple, tart (Granny Smith) or sweet (Fuji or Yellow Delicious), peeled, cored, and cut into 1- to 1 ½-inch chunks
1 firm, ripe pear, peeled, cored, and cut into 1- to 1-½-inch chunks
or
2 cups chopped fresh pineapple (1- to 1-½-inch chunks)
or
1 rounded cup chopped firm, ripe peaches or nectarines (1- to 1½-inch chunks)
1 rounded cup chopped firm, ripe plums (1- to 1½-inch chunks)
1. Preheat the broiler. Thread thefruits loosely on skewers. Broil for3 to 4 minutes. Turn and broil foranother 3 to 4 minutes, until tender.Serve warm, at room temperature,or chilled.
Zone yield per recipe. Less thanone protein block, 4 carbohydrateblocks
Copyright © 1999 Deborah Friedson Chud, M.D.. All rights reserved.
